Phase I: Development

In this phase, the Principal Investigator (PI) thoroughly examined the pertinent literature and conducted Focus Group Discussions (FGDs) involving key informants and the research team. The primary focus of these discussions was to glean insights from participants in formulating a program specifically designed to enhance the development of children under the age of 5 who reside in skipped-generation families, primarily cared for by their grandparents. Employing a semi-structured interview approach, the PI aimed to gather comprehensive data by posing inquiries such as: “What strategies or experiences have proven effective in nurturing the development of your grandchildren?” “As a primary caregiver, what challenges have you encountered in supporting your grandchildren’s development, and how did you address them?” and “From your perspective, how does community support contribute to the overall development and well-being of your grandchildren, and in what ways have you been involved in or contributed to such support?” The outcomes of this phase assisted stakeholders and researchers in understanding the circumstances of skipped generations and the development of children. It was also important to note the identified training needs of low-literacy grandparents, as well as the lack of support services and interventions.

This first phase emphasized not only enhancing grandparents’ developmental and skills but also assisting with socioeconomic and healthcare accessibility issues that may affect their ability to care for their grandchildren. The number of program activities, content, and material were well designed for cultural and contextual relevance. The first draft of the program was presented to and reviewed by the teachers and nurse practitioners to provide the researchers with additional feedback and to ensure scientific accuracy. The ABCD program was initially planned through community collaboration and in participation with healthcare professionals, grandparents, CDC teachers, VHVs, and the community leaders to make sure that the program would be feasible, acceptable, sustainable, and effective. After being reviewed, the ABCD program was revised and divided into four sessions (Table 1).

The ABCD Program Activities